Fundoscopy slides discussion

check if opthalmoscope is in good working condition
inform examiner that u would tell the pt that u r going to flash bright light in his eyes to have a look at the back of his eyes and during examination u will come very near to his face
ask him to fix his gaze at a distant object
DIM LIGHTs
examination of rt eye e ophthalmoscope held in rt hand and look through e ur rt eye vice versa is for lt eye
--hold instrument to eye e index finger on thelens dial
--approach from shallow angel (15--20 degree)
approach on the same level as equator
--note and comment on red reflex
--note and comment on anterior surface of eye
--come near and focus on retina
--identify optic disc and comment on colour ,cup,size and margins
--follow blood vessels in 4 quadrants
--seek to identify the macula and fovea
--some times 2 eyes of dummy will have 2 different pathologies
--report ur findings to the examiner

diabetic retinopathy (lazer)
extensive pan retinal photocoagulation for previous proliferative retinopathy
macula looks healthy, visual acuity at this stage is 6/9 and would be maintained at this level

diabetic retinopathy(background_)
fundas photograph rt eye, dot and blot haemorrhagess mainly temporal to the macula and a nerve fiber haemorrhage in the upper part of fundas,there is a cresent temporal to the optic disc which is e in normal limits

diabetic retinopathy(proliferative)
fine new vessels on the optic disc,dot/blot haemorrhages elsewhere, rainbow type leison in the lower part of the pic is an artefact,pt require panretinal photocoagulation to preserve vision

diabetoic retinopathy(maculopathy)
exudation temporal to macula and close to the fixation marker in the lt eye ,there r dot and blot haemorrhages temporal to macula ,this is classified as diabetic maculopathy

diabetic retinopathy(microaneurysm)
there r some red dots in the fundas which represent microaneurysm and small dot haemorrhages, the optic disc is normal and the optic disc vessel on it r also e in normal limits

this is a central retinal vein occlusion,the central vein became blocked and hydrostatic pressure developed which resulted in multiple ruptures e i n the capillary bed of the retina giving the appearance of 360 degree of retinal haemorrhage

BACKGROUND DIABETIC RETINOPATHY(NON PROLIFERATIVE)
appears as exudates.haemorrhages and microaneurysms.Microaneurysm leak plasma and lipid seen as hard exudate,Soft exudates r site of small retinal infarcts
IN PROLIFERATIVE DIABETIC RETINOPATHY COMMON IN IDDM AFTER "20 YEARS
there is a new vessel formation near the optic disc and fibrosis, The pt is then at the risk for haemorrhage,retinal detachment and ultimately blindness

Cotton Wool spots result from occlusion of retinal pre-capillary arterioles supplying the nerve fibre layer with concomitent swelling of local nerve fibre axons. They are white, flufy lesions in the nerve fibre layer. They are very common in Diabetic Retinopathy, especially if the person is also hypertensive.

Hard exudates are yellow deposits of lipid and protein within the sensory retina. Accummulations of lipids leak from surrounding capillaries and microaneuryisms, they may form a circinate pattern